1. Technical Field
The present invention relates to a surgical instrument system, in particular, for use in non-endoscopic surgery.
2. State of the Art
In endoscopic surgery, the instruments are inserted into natural corporal cavities through existing or artificially created entrances. Thus, the corporal cavity can be xe2x80x9cinflatedxe2x80x9d by means of a gas, for instance CO2, during the surgical measure and in this manner create or maintain the xe2x80x9coperation areaxe2x80x9d for the surgical procedure.
Conventional non-endoscopic surgery, i.e. surgery in which the human body is opened and the operation measures are not carried out in a natural corporal cavity, often anatomically given points of cutting are used to gain xe2x80x9caccessxe2x80x9d into the body. Preferably, work is conducted along so-called planes of separation or cutting planes. Contrary to corporal cavities, the different possible planes of separation are interconnected so that it is, in particular, impossible to use a gas that is under pressure for expanding and for scavenging the area immediately surrounding the instrument. One problem in surgery is, i.a., to move the (surgical) instrument gently forward along such types of natural cutting planes respectively planes of separation in the body.
In the present description, cutting planes or planes of separation refer to, for example, areas where different corporal layers or tissue layers, such as for instance different muscle tissue (layers) or muscle tissue and fat tissue or fat tissue and veins are adjacent to each other. In plain words, these types of planes are the interfaces between different regions, of which each can, in particular, be homogeneous.
The object of the present invention is to create a surgical instrument system that can be used in the human body or in animal bodies, in particular, in conventional, non-endoscopic surgery and that can be moved forward in a simple manner along natural cutting planes or planes of separation.
An invented solution to this object is based on the knowledge that water, in circumstances containing dissolved substances, such as salts, etc., is an ideal distention element for widening or separating corporal tissue along interfaces respectively planes of separation.
An element of the present invention is therefore that after opening the body, i.e. after creating an entrance, a surgical instrument is inserted from whose distal end a liquid jet emerges which xe2x80x9cwidensxe2x80x9d or xe2x80x9cseparatesxe2x80x9d the tissue so that a liquid bubble or a xe2x80x9cwater bubblexe2x80x9d can move forward in the center of natural cutting planes, which allow the surgical instrument to advance, in particular, without severing homogeneous tissue regions.
The added liquid is pumped off again using such evacuation power that (preferably) only one liquid bubble forms surrounding the distal end of the surgical instrument. In this way, the instrument can be moved forward along a natural cutting plane or a plane of separation, and the separation plane is opened by the pressure of the emerging liquid to at least such a degree that the surgical instrument can be inserted and moved forward. On the other hand, the pumping off of the liquid through the liquid bubble prevents too much liquid from being introduced, which would xe2x80x9cfloodxe2x80x9d the surgical field.
Therefore, the invented surgical instrument system, which is designed, in particular, for use in non-endoscopic surgery, is provided with
a surgical instrument having a shaft in which a supply channel with a distally disposed emergence opening for the liquid and a evacuation channel with a distally disposed draw-off opening for the liquid are provided, and
a pump device which pumps a liquid into the supply channel with such a pressure that the tissue in front of the distal end of the surgical instrument is separated along the natural planes of separation by the liquid emerging from the emergence opening, and which pumps the liquid out of the liquid bubble surrounding the distal end of the surgical instrument through the evacuation channel to the proximal end of the surgical instrument.
Preferably a surgical channel which permits the insertion of treatment instruments, such as instruments for cutting, expanding or coagulating, is provided in the shaft, in particular, in its center. In this way, the instrument not only can move forward along the planes of separation but surgery can also be performed without changing instruments.
In order to be able to observe the forward movement of the instrument as well as the performance of the surgical procedure, it is moreover preferred if the shaft is provided at with an endoscope optic or if the shaft is provided with a channel into which an endoscope optic can be inserted. In order to be able to observe the instrument advancing, in particular, if the endoscope optic is disposed off center, it is advantageous if the lens of the endoscope optic has a viewing direction optical axis respectively a lens-side optical axis which forms a small angle, which can be e.g., approximately 12xc2x0, with the longitudinal axis of the shaft.
Fundamentally, a variety of instruments, such as are in particular known from endoscopy, can be utilized as xe2x80x9csurgical shaft instrumentsxe2x80x9d.
However, it is preferred if the shaft has the basic construction of a laparoscope with a laterally offset observation means or eyepiece so that there is one continuous channel in the laparoscope. According to the present invention, a twin hollow needle, in which the supply channel and the evacuation channel are provided, is inserted into this channel. Moreover, the surgical channel can also be provided in the twin hollow needle, preferably in the center. The central disposal of the surgical channel yields an advantageous rinsing of the instrument inserted into the surgical channel.
If using a twin hollow needle in which the supply channel and the evacuation channel are provided, it is furthermore preferred if these are provided with the two connections for the pump device. These connections can be constructed in a variety of ways, for example as Luer-lock connections.
The pump device, for example, can be a (Sero) conditioning pump, regulated by an electronic control unit. The control unit regulates, or controls the pressure under which the liquid emerges in such a manner that it is adapted to the consistency or the density of the tissue layers to be separated. In a number of applications, it is preferred if the pressure under which the liquid emerges is between approximately 0.1 bar and approximately 1 bar.